NPIMap

Organization Active NPI

Marian David, MD, PC

  • Specialist
  • Kew Gardens, NY
National Provider Identifier
1194721043
Registry record updated Jun 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
211683 Issued in NY
Legal business name
MARIAN DAVID, MD, PC
Practice address
12510 Queens Blvd
Suite 2701
Kew Gardens, NY 11415-1519
Phone
(718) 261-0444
Fax
(718) 261-0940
NPI assigned
Jun 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marian David, MDNPI 1619073046
Title
Owner
Phone
(718) 261-0444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 211683 NY Primary

Addresses

Primary practice location

12510 Queens Blvd
Suite 2701
Kew Gardens, NY 11415-1519

Mailing address

12510 Queens Blvd
Suite 2701
Kew Gardens, NY 11415-1519
Phone (718) 261-0444

Other identifiers 1

IdentifierTypeStateIssuer
01877994MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000650 NY Part B Supplier - Clinic/Group Practice 6406743442 Receives reassigned benefits from 6 practitioners
Practice locations: Brooklyn, NY; Woodhaven, NY; Ridgewood, NY; Rego Park, NY; Kew Gardens, NY; Elmhurst, NY; Corona, NY

National Provider Directory

National Provider Directory
Tax ID family
Marian David MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12510 Queens Blvd
Ste 2701
Kew Gardens, NY 11415
Phone (718) 761-2950

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245283200000",
    "number": "1194721043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12510 QUEENS BLVD",
            "address_2": "SUITE 2701",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151519",
            "telephone_number": "718-261-0444",
            "fax_number": "718-261-0940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12510 QUEENS BLVD",
            "address_2": "SUITE 2701",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151519",
            "telephone_number": "718-261-0444",
            "fax_number": "718-261-0940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIAN DAVID, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2009-06-18",
        "status": "A",
        "authorized_official_last_name": "DAVID",
        "authorized_official_first_name": "MARIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-261-0444",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "211683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01877994",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kew Gardens, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.